The
27th Special Session of the General Assembly on Children
(UNGASS)

Judy LeVan
Fram, Jo Ann Gerling, and Kate Sharp represented LLLI at the 27th
Special Session of the General Assembly on Children which took
place May 8 - 10, 2002 in New York City, U.S.A.

Concluding
the special session on children, the UNGASS adopted a final document
A
World Fit for Children, setting out goals and a specific
plan of action to help millions of young people across the globe
to receive adequate education, health services and standards of
living.

Opening
remarks:
Dr Labbok stated that of the 580,000 deaths from HIV/AIDS in children
under 15 years of age, 500, 000 have been in Africa. She stated
that 80-90% of these were due to mother-to-child transmission
(MTCT), and estimated that 200,000 were secondary to breastfeeding.
She went on to state that breastfeeding, overall, has saved 5
million lives in the same time period. There has been an 8% increase
in the last 10 years in exclusive breastfeeding. This has saved
an extra $2 million on buying formula, and has delayed 6 million
births. Miriam stated that UNICEF's current policy is that women
who are not HIV-infected, or do not know their HIV status, should
exclusively breastfeed. In communities where it is acceptable,
feasible, affordable, sustainable and safe, they are recommending
to avoid breastfeeding.

"Optimal
feeding beyond six months", Dr Isaac Akinyele, Nigeria, Nutrition
expert:
Dr Akinyele recommended breastfeeding for 6 months, and then replacement
feeding. Adding high-selenium complementary foods may help to
decrease virus transmission. He also suggested that after 6 months
mothers can use cow's milk if pasteurized. He mentioned that some
people add crayfish, palm oils, and periwinkles. He stated that
one problem with a very poorly diversified diet is that micronutrient
needs for Ca, Fe, Vit. A and Zn are not met. He remarked that
the ability to use local foods is important, and mentioned a technique
called Co-fermentation of complementary foods by the mother, mixing
local foods and natural microorganisms in a bowl for 36 hours,
adding legumes, etc and then grinding them for the baby (6 months
or older). He stated that this strategy increases nutritional
value, and increases digestibility by breaking down some starches,
decreases viscosity (important in the 6-9 month semi-solid stage).

"Infant
feeding, infant survival, and mother-to-child transmission of
HIV - report from a four-country study", Dr Michael Latham,
Cornell University, Nutrition expert:
Dr Latham stated that there have been studies that have found
HIV in breast milk. However, decisions need to be made based on
risk assessment, as with other diseases. In the case of infant
feeding, all options have risks.

Risk of
transmission :

30 % of
infected mothers will transmit the virus (therefore, 70% of children
will NOT get the virus)

of these,
20% will transmit in utero or during childbirth ( therefore 10%
will not transmit during pregnancy/delivery) .

this leaves
10% who might transmit the virus during breastfeeding

therefore,
90% of infected mothers will NOT transmit the virus during breastfeeding.

In Namibia,
breastfeeding is still the norm, but in Botswana women were moving
away from breastfeeding. All countries have a high prevalence
of HIV, all are breastfeeding cultures, all have very different
policies in regard to MTCT/infant feeding and HIV. There has been
a major decline in breastfeeding in all these countries in recent
years, with low exclusive breastfeeding rates. There have been
declines in BFHI initiatives, and declines in support of the Code.
He went on to say that there is a widely held myth by health workers
that all mothers who are HIV+ will transmit HIV to their infants,
and so therefore they do not discuss the dangers of not breastfeeding.
He talked about the Coutsoudis study, which showed that there
is no significant difference in transmission between exclusive
formula feeding and exclusive breastfeeding.

"Socio-cultural
determinants of feeding choices - Africa", Chloe O'Gara,
Ready to Learn:
Ms. O'Gara mentioned the Vitamin A study in Zimbabwe, in 1999-2000:
of 221 women who received their HIV results and intensive counseling,
29% were +, and 95% of those chose to breastfeed. Most people
do not want to know their status, even if they can be tested.
She stated that 99 % of HIV+ women breastfeed

Lessons
learned from this close observation were:

In Rwanda,
a traditional salutation for new mothers is "May you breastfeed
well."

Cost is
an issue - the cost of replacement feeding is cost-prohibitive

Breastfeeding
is often delayed because of the belief that colostrum is 'diseased'

There
is a lot of "closet mixed feeding" and lots of mixed feeding
in general

There
is a strong belief that babies need water: in hot climates, the
"breast milk would get too hot if the mother is active and
this will hurt the baby".

"Socio-cultural
determinants of feeding choices - Brazil", Dr Marina Rea,
Sao Paolo, Consultant to the Minister of Health, Member/founder
IBFAN:
Dr Rea began by stating that in Brazil, ARVs are provided to everyone
free of charge. They use generic drugs and have agreements with
pharmaceutical companies. Dr Rea stated that the median duration
of exclusive breastfeeding in Sao Paulo, Brazil according to a
1999 survey is 9 days. Brazil has a huge human milk network. The
milk is pasteurized before it is given out. Brazil has made human
milk affordable. 71% of HIV+ women in Brasilia get banked milk
for their infants. Dr Rea stated that with pasteurization, milk
is heated to 62.5 degrees for 30 minutes, and this inactivates
the virus. In the year 2000, Brazil collected over 79,000 liters
of breastmilk.

"Socio-cultural
determinants of feeding choices- India", Dr Subha Raghavan,
Columbia University:
What this study found was that mothers decided to do what the
healthcare provider said to do and the healthcare workers were
biased themselves. Dr Raghavan noted there is a very high morbidity/mortality
rate among replacement fed babies. Due to this there is a new
national policy: during the first four months, babies should be
exclusively breastfed with gradual weaning at 4-6 months of age.
The challenge is now to disseminate this policy to the healthcare
workers.

"Infant
feeding in Resource-Poor Countries in the Face of HIV/AIDS : Lessons
Learnt", Dr Arun Gupta, Breastfeeding Promotion Network Of
India:
Dr. Gupta remarked that a major problem is that counselors do
not understand what "exclusive breastfeeding" means
and they believe that artificial feeding is safe. Physicians have
heard that there is viral transmission during breastfeeding, therefore
it is essential to train counselors with the most up-to-date breastfeeding.
His papers brought out clearly the risks associated with not breastfeeding
and called for ongoing and better research into the impact of
different feeding methods. He recommended working to decrease
mixed feeding as a way to increase exclusive breastfeeding as
well as to protect the child.

"How
to make breastmilk and breastfeeding safer", Helen Armstrong:
She stated that in the US there is a stigma against breastfeeding
while HIV+, and babies can be removed from their moms who are
breastfeeding them, while in many other parts of the world, not
breastfeeding leads to stigmatization. She notes that poor nutritional
status accelerates disease. In a Latin American study partial
breastfeeding was linked to a 4-fold increase in mortality, doubling
the rates of diarrhea and respiratory pneumonias, and no breastfeeding
was linked to a 15-fold increase in mortality, with rates of diarrhea
and respiratory pneumonia's quadrupling. Dr Armstrong commented
that even when HIV+ women do NOT breastfeed, we see increased
transmission in the first six weeks postpartum. She also noted
that between 1986 and the present, the exclusive breastfeeding
rate in Brazil increased from 4 to 40%. On the topic of safer
breastfeeding practices, Dr Armstrong spoke about the Coutsoudis
study, stating that mixed feeding has a higher rate of transmission.
She then went on to discuss a strategy for rapid cessation of
breastfeeding, clarifying that "the bottom line is that we
don't know if this is necessary" but that it can reduce subclinical
mastitis in the mom, which might increase transmission during
the weaning process. Based on an idea by Gabrielle Palmer, this
process has three stages: 1. mother continues to breastfeed but
starts to comfort the baby by other means and includes the family
more in emotional nurturing of the baby, and begins some hand
expression; 2. mom expresses more, heat treats the milk and cup
feeds, breastfeeding some, while continuing close comforting by
mom and family; and 3. mom stops breastfeeding, expresses and
heat treats the milk and comforts without nursing. Helen proposed
this as a three-week process.

"Global
water challenges and private-public sector partnerships",
Steve Hilton, Conrad Hilton Foundation:
Lack of access to safe drinking water affects 1/5 of the world's
population. 1.1 billion still do not have clean water, 2.4 billion
have inadequate sanitation. Diarrhea kills over 2 million children/year.
The Hilton Foundation is working in Ghana to improve the water
situation and accessibility, with the goal of decreasing diarrhea,
guinea worm disease, trachoma (causes blindness-- 540 million
are at risk).

"Environmental
Threats and Children's Health", Hans Trodesson, WHO perspective:
An unfinished priority of the last century is high mortality secondary
to infectious disease. There is a huge persistent problem of malnutrition.
Also now emerging are epidemics of non-communicable diseases and
injuries. One-third of the global burden of disease is due to
environmental exposures. 11 million children/yr. die - 99% in
developing countries. Killers: respiratory infections, diarrhea,
HIV/AIDS, and malaria. 60% of these deaths are related to malnutrition,
often related to poverty, often living in poor environments. The
Bangkok statement promotes protection of children's environments.